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Health Plans Seek Supreme Court Review in ACA "Risk Corridors" Cases

Client Alert | 1 min read | 02.12.19

On February 4, several health plans (including C&M client Maine Community Health Options) filed petitions for certiorari at the U.S. Supreme Court, seeking review of the Federal Circuit’s opinion in the ACA “risk corridors” cases, which held that while the risk corridors program contained a mandatory payment obligation on the part of the Government, that payment obligation was temporarily suspended by appropriations riders that restricted HHS funds available to satisfy the obligation, even though the riders did not amend or repeal the statutory payment obligation and even though the health plans had already performed their own reciprocal obligations under the statute. The petitioners are seeking review of the Federal Circuit’s opinion on several grounds, including (i) the restriction of funds to an agency via appropriations rider does not extinguish a statutory payment obligation of the United States, (ii) a rider that does not by its terms repeal or amend a money-mandating statute cannot impliedly and retroactively extinguish the Government’s payment obligation. The Maine petition is linked here. 

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Client Alert | 8 min read | 03.05.26

Fifth Circuit Decision in Health Care Fraud Case Highlights Importance of Careful Drafting in Civil RICO Complaints

A recent decision by the United States Court of Appeals for the Fifth Circuit, Farmers Texas County Mutual Insurance Co. v. 1st Choice Accident & Injury, LLC, No. 24-20275 (5th Cir. Feb. 24, 2026), offers important lessons for health care payors and other potential plaintiffs considering civil claims under the federal Racketeer Influenced and Corrupt Organizations Act (RICO). Although the Fifth Circuit’s decision focused on a procedural issue, the underlying case turned on a fundamental pleading failure: the plaintiff insurers did not adequately describe the fraudulent network they were suing as a RICO “enterprise.” The result was dismissal of a $14 million fraud case....